Implications of shunt morphology for the surgical management of extrahepatic portosystemic shunts.

OBJECTIVE: To describe the implications of extrahepatic portosystemic shunt morphology for the chosen site of shunt closure in dogs and cats. METHODS: A retrospective review of a consecutive series of dogs and cats managed for congenital extrahepatic portosystemic shunts. RESULTS: In total, 54 dogs and 10 cats met the inclusion criteria, revealing five distinct shunt types: left gastrophrenic, right gastrocaval (types Ai, Aii and Aiii), splenocaval, colocaval and left gastro-azygos. Without exception, findings of computed tomography angiography and direct gross observations at the time of surgery confirmed four consistent sites of communication between the anomalous shunting vessel and the systemic venous system: the caudal vena cava at the level of the epiploic foramen; the left phrenic vein at the level of the oesophageal hiatus; the azygos vein at the level of the aortic hiatus; and the caudal vena cava or iliac vein at the level of the 6th or 7th lumbar vertebrae. The use of intraoperative mesenteric portography was effective for confirming that at the time of surgery all portal tributary vessels were proximal to the point of shunt attenuation. CONCLUSIONS: Findings confirmed that for the common types of extrahepatic portosystemic shunts there were only four consistent sites of communication between the shunt and the systemic venous system. This information supports the use of a systematic approach for the location and attenuation of shunts in dogs and cats.

Repair of a transverse ilial fracture in a cat using an intramedullary pin.

OBJECTIVE: This case report describes the novel use of an intramedullary pin in an eight-month-old cat to repair malunion of a right transverse ilial fracture that was causing pelvic canal diameter narrowing and constipation. METHOD: A routine, right femoral head and neck ostectomy was performed due to the presence of a femoral head fracture with apparent femoral neck necrosis. Significant callus formation around the ilial fracture was removed in order to achieve satisfactory fracture reduction. A 2 mm Steinmann pin was passed in a retrograde fashion from the acetabular fracture towards the ischial tuberosity, and following removal of the trochar tip and reduction of the fracture, was driven normograde to end in the cranial ilial wing. The pin was bent at the ischium following cutting in an attempt to prevent cranial migration. RESULTS: Radiographic examination showed good fracture alignment and increased pelvic diameter by 31% The cat regained normal limb function and the constipation resolved. CLINICAL SIGNIFICANCE: A transilial pin was utilised successfully in a cat to realign and stabilise a simple transverse ilial fracture following femoral head and neck ostectomy. This technique has the potential to be useful for stabilisation of feline caudal ilial body fractures, but should not be used where there is articular surface involvement unless the coxofemoral joint is not preserved. Further studies are required to assess this technique.

Tension band stabilisation of acetabular physeal fractures in four kittens.

The surgical repair of acetabular physeal fractures in four kittens using a screw and tension band technique is reported. This was an appropriate method for restoring articular congruency and improving pelvic alignment. All cases had an excellent outcome and full limb use following fracture repair. In kittens younger than 12 weeks, there is a possibility of premature fusion of the acetabular bone resulting in development of a deformed, shallow acetabulum and hip subluxation. However, surgery is still justified when there is pelvic canal narrowing to decrease the risk of future defecatory problems. Early implant removal in such young kittens may decrease the severity of deformity caused by premature physeal closure. In kittens of 16 weeks or older, the prognosis is good for normal acetabular development and implant removal is not necessary.

Complications following full-thickness small intestinal biopsy in 66 dogs: a retrospective study.

OBJECTIVES: To retrospectively report the complications seen after full-thickness multiple small intestinal biopsies were performed in 66 dogs. METHODS: Animals that died as a result of enteric wound breakdown were compared with the surviving population to identify fatal risk factors. RESULTS: Seventeen dogs had hypoalbuminaemia and eight had albumin levels below 20 g/I at surgery. Twelve dogs had concurrent disease, of which seven had skin disease. Seven dogs suffered minor complications which resolved with treatment. Eight dogs (12 per cent) died or were euthanased between three and nine days postoperatively (mean [sd] 4.5 [2.1]) due to enteric wound breakdown. Seven of these dogs developed septic peritonitis and one died of haemorrhage. No statistically significant differences were identified in any of the parameters examined for the development of fatal enteric wound dehiscence. CLINICAL SIGNIFICANCE: Full-thickness intestinal biopsy is not a benign procedure. However, this study concludes that there are no consistent predictors for patients at increased risk of enteric wound breakdown.